Chinese herbal medicine alleviates renal impairment induced by immunosuppressants in patients post living donor liver transplantation.

Background and aim: Patients post liver transplantation (LT) with long-term immunosuppression agents will suffer from renal function impairment. Chinese herbal medicine (CHM) has been reported to relieve chronic kidney disease progression. Nevertheless, there are a lack of high-quality reports related to CHM reducing renal dysfunction in post-LT patients. We aim to investigate whether CHM alleviates renal impairment induced by immunosuppressants in patients having undergone LT. Materials and methods: We conducted a hospital-based retrospective cohort study including patients with LT from January 1, 2003 to March 31, 2020. We matched the CHM users to non-users at a 1:1 ratio according to baseline variables, comorbidities and drug use status by propensity score (PS) matching. Results: The study enrolled a total of 1052 LT patients. After PS matching, 554 patients were included with a 1:1 ratio. CHM and non-CHM users exhibited a significant difference of improved urine protein to creatinine ratio (UPCR) over several 3-month follow-up periods. CHM users exhibited an alleviated decrease in GFR compared to non-CHM users after 12 months of follow-up (CHM: 58.1 to 56.3 ml/min/1.73 m2; non-CHM: 59.8 to 54.7 ml/min/1.73 m2). Among HCC patients, CHM users had alleviated GFR, UPCR and blood urea nitrogen impairments compared to non-CHM users. The most commonly prescribed herbs and formulas are noted. Conclusion: We herein report that CHM could protect renal function after 12 months of follow-up compared to non-CHM users, without liver function impairment. However, the long-term effects and exact renal protection mechanisms require further investigations to confirm.